Oral Appliances: Let's Correct This Understanding

[DreamStalker]

Please stay on topic, Rooster. You don't want to make the original poster of this thread mad.

He's an idiot. Let the moron get mad for all I care.

Hey mister!

Now don't go calling my mad moron rooster friend an idiot ... especially now that he is coming around to changing his mind about government regulation. After all, the Chinese gotta eat too.

[akcpapguy]

When I ran the sleep lab at Walter Reed a few years back, every soldier who was diagnosed with OSA got a TAP oral appliance. We had a dentist who was specifically trained to fit them and he also defined strict parameters for the titration so that the patients TMJ was not over stressed. If the titration was successful, the soldier was able to escape the dreaded "non-deployable" profile, this have changed in recent years regarding that profile though. Ofcourse the soldiers were also given a CPAP machine and surgical options were discussed. From the numbers that I can remember, the success rate for the TAP was around 65-70%. I would strongly suggest that anyone pursuing this avenue find a sleep lab that will work with your dentist in designing a titration protocol for your night in the sleep lab.

[roster]

When I ran the sleep lab at Walter Reed a few years back, every soldier who was diagnosed with OSA got a TAP oral appliance. We had a dentist who was specifically trained to fit them and he also defined strict parameters for the titration so that the patients TMJ was not over stressed. If the titration was successful, the soldier was able to escape the dreaded "non-deployable" profile, this have changed in recent years regarding that profile though. Ofcourse the soldiers were also given a CPAP machine and surgical options were discussed. From the numbers that I can remember, the success rate for the TAP was around 65-70%. I would strongly suggest that anyone pursuing this avenue find a sleep lab that will work with your dentist in designing a titration protocol for your night in the sleep lab.

Very interesting and encouraging that they were that advanced at Reed.

What "changed regarding the profile"?

[akcpapguy]

Well since the face of war has changed, most soldiers (even Infantry) are staying of FOB's with electricity, an OSA diagnosis with CPAP use no longer means an automatic job reclassification if you are in the Combat Arms realm.

[remstarcpap]

I can suggest a more useful home experiment. Awake voluntary jaw protrusion means little or nothing, since no one snores until they fall asleep and relax.

What I did was to use my Ipod recorder with a microphone positioned right next to my face. I tested regular sleep (lying on back, no appliance, no cpap). Loud snoring can be heard on the recording, starting soon after I fell asleep.

Next I made a homemade jaw advancement device for $5 using a Brainpan athletic mouth protector which you boil and mold. I molded it pushing my lower jaw as far forward as practical.

Testing that device, my snoring was much reduced. Almost none.

I then validated the test with my sweetie, who is a very light sleeper, and who easily could sleep with me with the mouthpiece, and couldn't do it without due to snoring.

I now have a oximeter, so will repeat the experiment with that, and see what happens. The only problem is that I actually find cpap more pleasant than something in my mouth, so it's more of an academic exercise.

But unless insurance covers an oral appliance, I'd suggest borrowing, or buying an oximeter, a good digital recorder, and buying a $5 walmart boil and bite mouth protector, and seeing if the noise and the numbers suggest you will respond. If so, the next step makes sense. If not, I'd stick with cpap.

[gasp]

. . . I now have a oximeter, so will repeat the experiment with that, and see what happens. The only problem is that I actually find cpap more pleasant than something in my mouth, so it's more of an academic exercise. . . .

But unless insurance covers an oral appliance, I'd suggest borrowing, or buying an oximeter, a good digital recorder, and buying a $5 walmart boil and bite mouth protector, and seeing if the noise and the numbers suggest you will respond. If so, the next step makes sense. If not, I'd stick with cpap.

I read your post and wondered what the outcome was?

I have a relative that just began apnea therapy using XPAP. I was asked if there is a mouth device to keep the jaw forward that works so they can use when napping away from home. I told them about the doctor prescribed Mandibular Advancement Device the doctor made me which did not significantly reduce apnea events (per a sleep study done with the device). I can't remember right now what my cost was but I think it was around $400 with insurance paying the balance which I remember being around $1200 plus doctor visits. Anyway, too expensive an alternative for napping.



I did note to my relative that as time goes by on XPAP, they might experience a reduced need to nap : )

[benzmum]

This is an interesting discussion that I want to keep tabs on - but I gather the only way for me to get notifications of new activity is to post a reply, so that's what I'm doing. Sorry for the intrusion....

[robertmarilyn]

This is an interesting discussion that I want to keep tabs on - but I gather the only way for me to get notifications of new activity is to post a reply, so that's what I'm doing. Sorry for the intrusion....

That isn't the only way to be subscribed to a thread. At the bottom of the page, on the left, is a "subscribe topic" button. By using that button, you don't have to reply to a thread to get updates of it. Also, you can unsubscribe to a thread that you don't want updates on, by clinking the "unsubscribe topic" button (same place).

mar

[benzmum]

That doesn't work for me... but we're off topic.

[Velbor]

I would posit that these three practical indicators can suffice in lieu of that sleep study: 1) a marked improvement in perceived quality of sleep, 2) a marked improvement in daytime cognition, and 3) satisfactory SpO2 scores during a simple nocturnal oximetry test.

This discussion regarding follow-up PSG's and oral appliances seems to be in in the context of the PSG as a go/no-go decision in terms of efficacy, and this is certainly a part of the process.

However, non-users of oral appliances particularly should remember that these are typically not "plug-n-play" devices, but adjustable, "titratable" instruments. Therapy generally begins with very little forward mandibular advancement, and gradually progresses, until a combination of a) symptomatic improvement and b) statistical criteria are met.

It is typically at this point that a (repeat) PSG is done, not so much to determine whether the appliance is FUNCTIONAL, but to determine whether the TITRATION of the appliance is OPTIMAL. There is always a balance between what the device is doing to the jaw, and what effect the device is having on OSA.

xPAP "titration" is traditionally done BEFORE therapy is started. The general sense around here is that all xPAP users should have data-capable machines, to monitor subsequent therapy, and I agree. Oral appliance users have no such objective feedback mechanism, short of the "titration-confirmatory" PSG done AFTER therapy well in progress. (Use of adjunctive pulse oximetry is becoming increasingly popular, but I don't think that anyone yet is recommending it as an ALTERNATIVE to machine data.)

The indicators suggested by -SWS are good ones, regardless of the particular therapy for OSA being employed. But unless we're ready to say that they're sufficient for xPAP users as well, I don't think that they can appropriately substitute for a confirmatory PSG for appliance users. Velbor